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Only in the study from New Zealand an increased trend was observed [ 23 ]. Provided that fast food consumption as well as frequency of ordered food tended to decrease, a possible explanation could be that the long time staying at home during lockdown made people to spend more time in cooking and preparing homemade food, as has already be found in some studies [ 24 , 40 , 56 ]. Another explanation could be the fear of transmission of COVID disease via packets of food and delivery services, but further research is needed in this field.
Our results with respect to alcohol during the lockdown period showed that for the majority of the population examined the consumption remained stable [ 17 , 21 , 23 , 24 ,  ,  ,  , 33 , 35 , 36 ,  ,  ,  ,  , 43 , 44 , 46 ]. However, a significant portion of the population examined increased its alcohol consumption during the confinement time [ 17 , 23 , 24 , 26 , 27 , 29 , 35 ,  ,  ,  ,  ,  ,  ,  , 46 ].
Heterogeneity in results regarding alcohol consumption can be observed even in the same country. Results from China varied, where in Sun et al. However, in both studies the sample was not representative of the country’s population. Moreover, the period of survey between these studies was different 24—31 March in Sun et al. An explanation of the fact that different results emerged could be that in the beginning of the lockdown the anxiety and the fear of this unknown situation as well as the sudden change of daily life made people more prone to alcohol consumption compared to the end of lockdown.
Similar assumptions were also made about results from France [ 35 , 36 ] and Australia [ 41 , 43 ], where a tendency towards decrease in alcohol consumption at the end of the lockdown in comparison to the beginning was observed.
Results from USA were also differed between the studies [ 17 , 27 , 39 ]. In Avery et al. The same pattern was also observed in polish population where Therefore, the population in USA and Poland, in contrast to Chinese, French and Australian population, found to consume more alcohol in the end compared to the beginning of the lockdown. Data regarding the period of the survey conduction was not available in Ingram et al. However, in Ingram et al. In order to cope with this, a significant portion of the population relapsed to previous abuse as reported by Zhao et al.
Nevertheless, subjects who often consume alcohol are not only more prone to viral and bacterial infections including COVID due to their impaired immune system [ 58 , 59 ], to CVD in heavy drinking occasions [ 60 ], liver [ 61 ], and pancreas diseases [ 62 ], but they also affect the quality of life of people living around them e.
However, according to a recent systematic review the evidence is not enough regarding domestic violence and alcohol abuse during COVID [ 64 ], but awareness of reliability of this data is always needed [ 65 ]. Among the strengths of our study is the number of studies included as well as the fact that a significant geographical part of the world was covered.
Moreover, this is the first systematic review examining changes in eating patterns snacking, fast-food, and ordered food as well as in alcohol consumption. In addition, all studies included in this review were assessed according to the Newcastle—Ottawa Scale Suppl. Limitations of our studies include the fact that the sample of some studies was not representative for the population of each country and this could affect the accuracy of our results.
Moreover, p-values were not reported in all our included studies, therefore not allowing us to provide information on the statistical significance of related results. Lastly, in this systematic review studies only in English language were included and therefore related studies published in other languages might have been missed.
During the period of lockdown due to the COVID pandemic, changes in lifestyle behaviors were observed for a significant percentage of the global population. A tendency towards increased in snacking as well as in alcohol consumption should not be disregarded because long-term problems could be arising especially in cases of repeated lockdowns in future.
The observed decrease in fast-food consumption and in frequency of ordered food demonstrate an encouraging turn to home-made foods. However, provision and campaigns regarding nutritional information could be useful in order to combat with this pandemic.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. J, and MC revised the manuscript. All authors have read and approved the final version of manuscript. Clin Nutr. Dimitra Rafailia Bakaloudi , a Dhanushya T. Dhanushya T. Author information Article notes Copyright and License information Disclaimer. Received Jan 22; Accepted Apr All rights reserved.
Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre – including this research content – immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source.
This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1. Abstract The pandemic of coronavirus disease COVID and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide. Results 3. Search results The process for the studies selection is presented as a flow diagram in Fig. Open in a separate window. Table 1 Characteristics of Included studies All online surveys.
Snacking habits Several studies had examined changes in snacking behavior during the period of lockdown [ 22 , 24 ,  ,  ,  , 32 , 34 , 37 , 38 ] and the results are shown in Table 2.
Table 2 Changes in snacking during lockdown. NA not available. Fast-food and ordered food consumption Changes in fast-food consumption were reported in eight studies [ 19 , 20 , 24 , 25 , 28 , 34 , 35 , 46 ] and changes in ordered food were examined in three studies [ 15 , 18 , 23 ], whereas relevant results are summarized in Table 3 , Table 4 respectively. Table 3 Changes in consumption of fast-food during lockdown. Table 4 Changes in frequency of ordered food during lockdown.
Calculated according to existing results. Table 5 Changes in alcohol consumption during lockdown. Calculated by the existing results. Alcohol consumption Changes in alcohol consumption during the lockdown period were reported in 23 cross-sectional studies [ 16 , 17 , 21 , 23 , 24 ,  ,  ,  ,  , 31 ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ].
Discussion According to our knowledge, this is the first systematic review which aim was to examine changes in snacking behavior including both sweet and salty snacks , fast-food, food ordering habits, and alcohol consumption. Conclusions During the period of lockdown due to the COVID pandemic, changes in lifestyle behaviors were observed for a significant percentage of the global population. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest The authors declare no conflict of interest. Appendix A. Supplementary data The following are the Supplementary data to this article: Multimedia component 1: Click here to view. Multimedia component 2: Click here to view. Multimedia component 3: Click here to view. References 1. Baloch S. Tohoku J Exp Med. Koh D. COVID lockdowns throughout the world. Occup Med Lond. Clay J. Lancet Publ Health. Anton S. Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults?
Behav Modif. Moynihan A. Eaten up by boredom: consuming food to escape awareness of the bored self. Front Psychol. Janati Idrissi A. Sleep Med. Pinto J. Sleep quality in times of Covid pandemic. Crispim C. The influence of sleep and sleep loss upon food intake and metabolism. Nutr Res Rev. Muscogiuri G. Van Gaal L. Mechanisms linking obesity with cardiovascular disease. Chobot A. Obesity and diabetes-Not only a simple link between two epidemics. Diab Metab Res Rev.
Health risks and benefits of alcohol consumption. Liberati A. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Herzog R. Newcastle-Ottawa Scale adapted for cross-sectional studies. Alhusseini N. J Publ Health Res. Ammar A. Int Online Surv. Avery A. Stress, anxiety, and change in alcohol use during the COVID pandemic: findings among adult twin pairs.
Front Psychiatr. Cheikh Ismail L. Assessment of eating habits and lifestyle during coronavirus pandemic in the MENA region: a cross-sectional study. Br J Nutr. Chodkiewicz J. Constant A. Socio-cognitive factors associated with lifestyle changes in response to the COVID epidemic in the general population: results from a cross-sectional study in France.
Gerritsen S. Dietary and lifestyle changes during covid and the subsequent lockdowns among polish adults: a cross-sectional online survey plifecovid study. Husain W. Environ Health Prev Med. Ingram J. Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID lockdown. Knell G. Kriaucioniene V. Malta D. Clinical Nutrition and Dietetics; Mumbai, India: Panagiotidis P.
Dermatol Ther. Pellegrini M. Robinson E. Obes Sci Pract. Rolland B. PloS One. Rossinot H. Eating habits and physical activity of the Spanish population during the covid pandemic period. Scarmozzino F. Covid and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample; p.
Sharma P. Changes in substance use among young adults during a respiratory disease pandemic. Hepatol Commun. Sidor A. Stanton R. Depression, anxiety and stress during COVID associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Also, focusing the analysis on the concepts of convergent and sequential designs allowed us to clarify and refine their definitions. Considering that the focus of the analysis was the synthesis process in SMSRs, the literature on process studies especially in the fields of management provides insight into these concepts.
First, in line with Langley et al. Researchers are working forward in a non-linear manner guided by a cognitive representation of new data-based synthesis or results-based synthesis or interpretation of results to be created. Second, in line with Van de Ven [ 39 ], a sequential synthesis design can be defined, according to a developmental perspective phase 1 informing phase 2; phase 2 building on the results of phase 1 , as a change of focus at the level of data or synthesis over time and as a cognitive transition into a new phase e.
The synthesis designs found in this review of reviews reflect those suggested by Sandelowski et al. In this review of reviews, we used the mixed methods concepts and terminology because they account for the integration that may be present at the level of data, results, interpretation, or design. As in Heyvaert et al.
In Heyvaert et al. This was not done in this review of reviews because measuring or documenting the dominance of a method is difficult given the influences of multiple factors power, resources, expertise, time, training, and worldviews of each research team member, among other factors.
Also, in Heyvaert et al. In this review of reviews, the focus was put on where the integration occurred. Therefore, this review of reviews resulted in respectively four and three types of synthesis designs and methods, which led to propose 12 synthesis strategies, as compared to 18 in Heyvaert et al.
In Frantzen and Fetters [ 40 ], three main types of convergent designs are suggested see Table 1. Similarly, this review of reviews also found qualitative, quantitative, or mixed convergent synthesis design types. However, no distinction was made during the analysis between SMSRs including only qualitative and quantitative studies basic type and those also including mixed methods studies advanced type because this review of reviews aimed at defining ideal types of synthesis designs.
The paper written by Frantzen and Fetters [ 40 ] went into deeper analysis of convergent design to provide detailed information on the steps to follow to integrate qualitative, quantitative, and mixed methods studies. Some SMSRs using sequential synthesis design were found in our sample of reviews. Pluye and Hong [ 10 ] suggested using the sequential exploratory or explanatory designs.
In the exploratory sequential design, a qualitative synthesis is performed first and results inform the subsequent quantitative synthesis. Conversely, in an explanatory sequential design, the quantitative synthesis is done first and informs the subsequent qualitative synthesis. In this review of reviews, the sequence was defined as the results of one phase informing the other not limited to the order of the syntheses and no review was classified as sequential explanatory.
In addition, 12 SMSRs performing only qualitative syntheses were found and could not be classified as exploratory or explanatory. For the sake of parsimony, we did not make a distinction between exploratory and explanatory sequential synthesis designs.
In light of this review of reviews and the literature on mixed methods research, four complementary key recommendations can be made regarding the title, justification, synthesis methods, and the integration of qualitative and quantitative data.
First, researchers should explicitly state in the title that the review included qualitative and quantitative evidence. Various terms are used to designate this type of review. The term mixed has been used in the mixed methods literature to designate primary research designs combining qualitative and quantitative approaches [ 23 ].
In the field of review, mixing qualitative and quantitative evidence can be seen at two levels: study level and synthesis level [ 22 ]. Pluye et al. This name focuses on the study level and does not prescribe a specific synthesis method. Others have suggested labelling this type of review as mixed methods review [ 6 , 22 ] wherein mixing occurs at both the level of the study and the synthesis.
Another popular term is integrative review proposed by Whittemore and Knafl [ 5 ]. Integrative review is described as a type of literature review to synthesize the results of research, methods, or theories using a narrative analysis [ 41 ]. Currently, all these terms are used interchangeably without a clear distinction [ 40 ]. Second, researchers should provide a clear justification for performing a SMSR and describe the synthesis design used.
This lack of justification for using qualitative and quantitative evidence is also found in the literature on mixed methods research [ 42 ]. The rationale will influence the review questions and the choice of the synthesis design.
For example, if quantitative and qualitative evidence is used for corroboration purpose, the convergent synthesis design may be more relevant. On the other hand, when they are used in complementarity such as using the quantitative studies to generalize qualitative findings or using qualitative studies to interpret, explain, or provide more insight to some quantitative findings, the sequential synthesis design may be more appropriate.
Third, results of this review of reviews suggest a need to recommend that researchers describe their synthesis methods and cite methodological references. Various synthesis methods have been developed over the past decade [ 13 , 32 , 33 , 43 ]. Meta-analysis is the best known synthesis method to aggregate findings in reviews, especially for clinical effectiveness questions. However, when this method is not possible, researchers tend to omit describing the synthesis. In some SMSRs, narrative analysis corresponded to summarizing each included study.
In others, it consisted in grouping the different findings of included studies into main categories and summarizing the evidence of each category. Still, others followed Popay et al.
Hence, in addition to naming the synthesis method, we recommend that reviews should provide a clear description of what was done to synthesize the data and add methodological references. This will improve transparency of the review process, which is an essential quality of systematic reviews. Fourth, researchers should describe how the data were integrated and discuss the insight gained from this process.
Integration is an inherent component of mixed methods research [ 15 ], and careful attention must be paid to how integration is done and reported to enhance the value of a review. The synthesis designs outline that can provide guidance on how to integrate data Fig. Also, the discussion should include more than a simple wrap-up of results. It should clearly reflect on the added value and insight gained of combining qualitative and quantitative evidence into a review. The search strategy used was not comprehensive; thus, not all SMSRs were identified in this review of reviews.
Indeed, the search was limited to six databases mainly in health and no hand searching was performed. As this review of reviews deals with methods, citation tracking of included SMSRs would not have provided additional relevant references.
To ensure a manageable sample size, selection of included reviews was limited to peer-reviewed journal articles. We acknowledge that the sample of included reviews might not include some innovative developments in this field, given that some recent SMSRs may be reported in other types of publications e. Finally, the synthesis methods were not classified as aggregative and configurative [ 45 , 46 ].
As mentioned in Gough et al. To avoid this confusion, the terms qualitative and quantitative synthesis methods were preferred. Moreover, these terms were used to align with the mixed methods research terminology. Yet, as discussed in the Methods section, the interpretation of some synthesis methods used in this review of reviews can be debatable.
The field of SMSR is still young, though rapidly evolving. This review of reviews focused on how the qualitative and quantitative evidence is synthesized and integrated in SMSRs and suggested a typology of synthesis designs. The analysis of this literature also highlighted a lack of transparency in reporting how data were synthesized and a lack of consistency in the terminology used. Some avenues for future research can be suggested. First, there is a need to reach consensus on the terminology and definition of SMSRs.
Moreover, given the wide range of approaches to synthesis, clear guidance and training are required regarding which synthesis methods to use and when and how they should be used. Also, future research should focus on the development, validation, and reliability testing of quality appraisal criteria and standards of high-quality SMSRs.
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